Challenges of information communication technology use for improving health and well-being

Abstract

Information communication technologies (ICTs) promise to revolutionize healthcare, but digital health inequalities and inappropriate use might hamper health and well-being. Little is known about digital health inequalities in Chinese. Evidence and guidelines for screen time and internet use disorders (e.g. problematic smartphone use [PSU], internet gaming disorder [IGD]) are lacking for young and older adults. This thesis examined associations of 1) sociodemographic and health-related characteristics with online health information seeking and experiences, 2) screen time with PSU and sleep health, 3) PSU/IGD with individual and family well-being in Hong Kong Chinese population.

First, the Hong Kong Family and Health Information Trends Survey 2016/17 collected information on sociodemographic and health-related characteristics, online health information seeking and experiences, Smartphone Addiction Scale-Short Version for PSU, screen time, mental health, and family communication and well-being from 10143 landline and mobile phone respondents. Second, a prospective cohort of 307 university students completed an online survey on sociodemographic and health-related characteristics, gaming behaviors, and Internet Gaming Disorder Scale–Short-Form for IGD in 2019 and were followed up at 6-month. 4-week Ecological momentary assessment of 41 cohort participants informed multilevel modeling of associations between screen time (total, mobile gaming) and sleep problems. Bivariate and multivariable logistic/linear and modified Poisson regressions were used.

Participants with lower educational attainment and monthly household income were less likely to use internet websites (both P for trend<0.001), social networking sites (SNS; P for trend<0.001 to 0.08), and instant messaging (IM; P for trend<0.001 to 0.02) for health information seeking and were more likely to report effort, frustration, and online information being too hard to understand (education: P for trend<0.001; income: P for trend=0.001 to 0.06).

Every 1-hour increase in using SNS/IM was associated with PSU severity (adjusted unstandardized linear regression coefficient [b]=1.42, 95% confidence interval [CI] 0.35, 2.49; adjusted standardized linear regression coefficient [B]=0.18). PSU severity was associated with anxiety and depressive symptoms (adjusted odds ratio [AOR]=1.03 to 1.04, both P<0.001), lower subjective happiness (adjusted b=-0.006, 95% CI -0.010, -0.003; adjusted B=-0.07) and mental well-being (adjusted b =-0.04, 95% CI -0.07, -0.01; adjusted B=-0.10), and lower family well-being (adjusted b=-0.011, 95% CI -0.018, -0.004; adjusted B =-0.07) mediated through lower family communication sufficiency (76%) and quality (96%). These associations were generalizable across sex, age, educational attainment, and monthly household income.

In university students, every 1-hour increase in mobile gaming (weekend) was prospectively associated with IGD severity (adjusted b=1.44, 95% CI 0.40, 2.49; adjusted B=0.26). IGD severity had a marginal prospective association with incident depressive symptoms (AOR=1.10, 95% CI 1.00, 1.23). Ecological momentary assessment found every 1-hour increase in mobile gaming predicted any insomnia symptoms (AOR=1.34, 95% credible interval 1.05, 1.67) that further increased mobile gaming time (AOR=2.02, 95% credible interval 1.25, 3.09).

Correlates of online health seeking and experiences can inform support for digital health communication in disadvantaged groups. Results on screen time can guide interventions and guidelines for adults’ quantity and content of screen use. Prospective studies and trials are needed to establish causality and mechanisms underlying health impacts of PSU/IGD.